%0 Case Reports
%T A clinical case of insulin autoimmune syndrome with monoclonal gammopathy of uncertain significance; complexity in management.
%A Clifford L
%A Joseph F
%A Joshi T
%J Oxf Med Case Reports
%V 2024
%N 6
%D 2024 Jun
%M 38860020
暂无%R 10.1093/omcr/omae054
%X Insulin autoimmune syndrome (IAS) is a rare cause of spontaneous hypoglycaemia. We discuss a 91-year-old Caucasian lady who presented with syncope and episodic adrenergic and neuroglycopenic symptoms. Despite significantly elevated insulin, C-peptide, and proinsulin levels with the presence of anti-insulin antibodies, a pancreatic mass was not identified. Serum immunoelectrophoresis demonstrated monoclonal gammopathy of undetermined significance (MGUS). Treatment involved high-dose steroids, diazoxide, corn starch and acarbose, however the patient passed away four months later due to worsening co-morbidities. The management of IAS in the setting of MGUS is challenging.